CMS Expands Opportunities for Docs to Qualify as Advanced APMs under MACRA | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

CMS Expands Opportunities for Docs to Qualify as Advanced APMs under MACRA

October 25, 2016
by Rajiv Leventhal
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As requested by industry stakeholders, feds add more paths for Medicare clinicians in MACRA

The Centers for Medicare & Medicaid Services (CMS) has announced new opportunities for clinicians to join advanced alternative payment models (APMs) under the Quality Payment Program created through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

With the release of the MACRA final rule earlier this month, federal officials have designed what they call a more modern, patient-centered Medicare program, the Quality Payment Program, which will reform Medicare payments for more than 600,000 clinicians across the country by promoting quality patient care while controlling escalating costs through the Merit-Based Incentive Payment System (MIPS) and incentive payments for advanced Alternative Payment Models (Advanced APMs). Clinicians that have sufficient participation in an advanced APM will be exempt from MIPS reporting requirements and payment adjustments.

For months since the proposed rule was released, a key talking point was what would qualify as an advanced APM, and further, if the prerequisites for these alternative payment models were too aggressive in terms of how the government defined the “nominal risk” financial requirement. Advanced APMs are a subset of APMs and let practices earn more for taking on some risk related to patients’ outcomes.

As reported by Healthcare Informatics, much of this was cleared up in the Final Rule. For one thing, CMS announced a new advanced APM in 2018—ACO Track 1+, which has lower levels of risk than other accountable care organizations (ACOs). CMS also changed one of the qualifications for participation in advanced APMs to be practice-based as an alternative to total cost-based.

And now, the latest announcement from CMS reveals that it expects to re-open applications for new practices and payers in the Comprehensive Primary Care Plus (CPC+) model and new participants in the Next Generation ACO model for the 2018 performance year. In addition, CMS is announcing that the Innovation Center’s Oncology Care Model with two-sided risk will now be available in 2017, which will qualify the model as an advanced APM beginning in the 2017 performance year.

In 2017, under the Quality Payment Program, clinicians may earn a 5 percent incentive payment through sufficient participation in the following Advanced APMs:

  • Comprehensive ESRD Care Model (Large Dialysis Organization (LDO) arrangement)
  • Comprehensive ESRD Care Model (non-LDO arrangement)
  • CPC+
  • Medicare Shared Savings Program ACOs - Track 2
  • Medicare Shared Savings Program ACOs - Track 3
  • Next Generation ACO Model
  • Oncology Care Model (two-sided risk arrangement)

In 2018, CMS said that it anticipates that clinicians may also earn the incentive payment through sufficient participation in the following models:

  •     ACO Track 1+
  •     New voluntary bundled payment model
  •     Comprehensive Care for Joint Replacement Payment Model (Certified Electronic Health Record Technology (CEHRT) track)
  •     Advancing Care Coordination through Episode Payment Models Track 1 (CEHRT track)

These lists will continue to change and grow as more models are proposed and developed in partnership with the clinician community and the Physician-Focused Payment Model Technical Advisory Committee, CMS said in its announcement.

“With these new opportunities, CMS expects that by the 2018 performance period, 25 percent of clinicians in the Quality Payment Program will earn incentive payments by being a part of these advanced models,” said Patrick Conway, M.D., deputy administrator of CMS. “Thanks to MACRA and the Innovation Center, we’re striving to see more Medicare patients benefit from better care when they visit their doctor for a knee replacement, receive cancer treatment, or have a coordinated care team manage their complex conditions.”

CMS Acting Administrator Andy Slavitt added, “Every day, the CMS Innovation Center is improving the future of Medicare by testing innovative care models across the country. Now, thanks to the bipartisan MACRA, clinicians have more opportunities and motivation to join these evidence-based approaches, which aim to improve care quality while creating cost savings.”

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